Monday, October 31, 2016

"Eighteen months after a donated liver from a stranger saved the life of Ottawa Senators owner Eugene Melnyk, his case has helped prompt Canadian transplant officials to accept that public pleas for living organ donors are ethical, legal and even beneficial, under the right circumstances.

Melnyk was one of two high profile cases in 2015 (the other was the family of twin girls from Eastern Ontario, the Wagners) in which public pleas were made for a liver donor. Hundreds of people answered the call to donate parts of their livers to save Melnyk’s life. His eventual transplant was a success and both Melnyk and his anonymous donor — who was described only as a Senator’s fan — recovered. Little Binh Wagner also recovered from a successful liver transplanted from an anonymous donor (her twin sister received part of their father’s liver).

The cases raised ethical questions about the fairness of public pleas that tend to favour those with more compelling stories over others legitimately waiting for an organ transplant. They also highlighted the fact that there is no national policy on organ solicitation, a gap the Canadian Society of Transplantation, the Canadian National Transplant Research Program and the Canadian Blood Services hope to close with guidelines released this week.

The guidelines acknowledge that ethical questions remain, but note that the gap between supply and demand of organs and the availability of public platforms to easily make such pleas means those questions are going to continue.

Dr. Atul Humar, medical director of transplant at the University Health Networks in Toronto where Melnyk’s and Binh Wagner’s transplants were performed, said public solicitations are increasing, mainly because of easy access to social media and a shortage of organs to transplant. Earlier this year, Gianna-Lynn Favilla, an eight-year-old Russell girl, received a life-saving liver transplant after the family made a desperate public plea on her behalf. The donor was a neighbour and the father of Gianna-Lynn’s best friend.

At the end of 2014, 4,514 patients (3,473 for a kidney and 507 for a liver) were waiting for an organ in Canada. During the same year, 2,356 transplant procedures were performed and 278 patients died while on the waiting list."
...
"The issue has caused some soul searching among transplant officials in Canada and around the world. Some institutions have refused to transplant organs obtained from public solicitation and the practice is banned in Australia. Recently, European transplant officials came to a similar conclusion as the Canadian guidelines: “As long as donor shortage persists, we should not condemn patients, who do not have a live kidney donor, or only have a very slim chance of finding a suitable donor when they decide to publicly solicit for a live donor.”

"[Tissues] are used in a wide variety of ways: to reconstruct breasts after cancer treatment. To repair joints in knees and ankles. To treat wounds of diabetics suffering from foot ulcers. To bridge bones in spinal fusion surgeries.

Douglas Wilson, LifeNet Health’s executive vice president, puts it into perspective this way: In one month, LifeNet provides solid organs for 40 to 60 patients, most of whom live in Virginia. But in terms of tissue transplants, some 40,000 patients a month across the globe receive LifeNet bioimplants.

That branch powers the growth of LifeNet, a nonprofit in the burgeoning Princess Anne bioscience corridor with operating revenue that topped $200 million last year. Solid organ recoveries went from 385 in 2011 to 467 last year, and tissue transplants from 389,000 to 462,000.

LifeNet is one of 58 organ procurement organizations in the country, and one of more than 100 accredited tissue banks. By law, companies can’t sell human tissue, but they can charge fees for recovery, processing, storing and distributing tissue.

And LifeNet fiercely guards its techniques. In 2014, the organization took a rival tissue transplant company to court, saying it used LifeNet’s patented technology to preserve tissue grafts and bone.

A federal jury awarded nearly $35 million to LifeNet, a finding that was appealed by the New Jersey-based LifeCell Corp., but upheld by a federal appeals court last month.

Wilson expects the growth in the tissue transplant field – which includes both for-profits and nonprofits – to continue, considering a few trends:

More older people will experience worn-out knees, hips, tendons and spinal discs. Obesity rates will fuel more diabetes cases with ulcers that require tissue transplants. And there’s the explosive field of regenerative medicine, which focuses on replacing and regenerating human cells.

“We’re sending tissue to every state and 30 countries,” Wilson said. “Allografts are used in almost every hospital in the U.S.”

When technical specialist Craig Wolf came to work at LifeNet 28 years ago, he was one of 44 employees. The number now? Nearly 900. The company has 600 products, 60 patents and branch offices in Washington and Florida."

"Clinical trial recruitment has long been one of the most challenging areas of drug development, with the potential to add significant costs and delays. And as the medical field gains a greater understanding of cancer pathways and genomics, finding patients for these trials has become only more complex.

Now a number of technology companies are aiming to solve that problem by helping providers identify clinical trials for patients who might qualify.

...

"At any given time, there are as many as 180,000 ongoing clinical trials, each with its own specific inclusion and exclusion criteria. Meanwhile, physicians have only 15 minutes, in many cases, to explore these options with a patient"

Monday, October 24, 2016

High school admissions in NYC may end with a (well designed) deferred acceptance algorithm, but the process starts long before students and some schools submit their preference lists. The Atlantic writes about how it is hard to form preferences over high schools, and to signal them to the schools through 'demonstrated interest'...

How Can We Improve Economic Opportunities for Low-Income Children?

In this series of lectures, Raj Chetty will discuss findings from the Equality of Opportunity Project, which uses big data to develop new answers to this important and timely policy question. The presentation will show how children's opportunities to climb the income ladder vary substantially depending upon where they grow up.It will then identify factors that contribute to this geographic variation in opportunities for upward mobility. The talks will conclude by offering policy lessons for how social mobility and economic opportunity can be increased in the next generation.

About the speaker: Raj Chetty is a Professor of Economics at Stanford University. His research combines empirical evidence and economic theory to help design more effective government policies. His work on tax policy, unemployment insurance, and education has been widely cited in media outlets and Congressional testimony.

This event is free and open to all with no ticket or pre-registration required. Entry is on a first come, first served basis

For more information on how to attend, please visit the LSE Events office webpage at:

Saturday, October 22, 2016

"The online service, which connects owners of homes and flats with tourists and other renters in cities around the world, has often clashed with regulators which accuse the company of facilitating illegal hotel businesses and reducing affordable housing stock.

In New York, hotel unions and New York City officials have been particularly vociferous on the company’s failure to comply with a 2010 accommodation law that banned short-term rentals in Manhattan, but which is rarely enforced.

On Wednesday, Airbnb said that it wanted to pay taxes in New York, estimating that it could generate about $90m a year in the state under its new registration scheme. The company also proposed a new “three strikes” rule that would permanently ban hosts who broke the 2010 law more than three times.

The company has already reached agreements on collecting and remitting taxes with many other cities, including Paris, its largest market. In New York City, Airbnb hosts 46,000 flats and homes.

Like other such Silicon Valley start-ups that have disrupted traditional business models, Airbnb has been forced, often through confrontation, to become more responsive to local regulators and interest groups as it expands."
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And, after the governor signed the bill,Airbnb Sues Over New Law Regulating New York Rentals
"Hours after Gov. Andrew M. Cuomo of New York signed a bill that would impose steep fines on Airbnb hosts who break local housing regulations, Airbnb filed a federal lawsuit contending the new law would cause it “irreparable harm.”

The heightened battle in New York follows lawsuits that Airbnb has filed against its hometown San Francisco and in Santa Monica, Calif., which have both moved to fine the company for illegal listings.

The company, which operates in a regulatory gray area around the globe, is also fighting tough battles in Amsterdam and Barcelona, Spain, which penalizes hosts who list illegal rentals, and in Berlin, which has banned most short-term rentals."

"Fifth, once refugees have been recognized, there needs to be a mechanism for relocating them within Europe in an agreed way. It will be crucial for the EU to fundamentally rethink the implementation of its stillborn resettlement and relocation programs; a tentative step in this direction was taken last week in new proposals put forth by the European Commission. The union cannot coerce either member states or refugees to participate in these programs. They must be voluntary; a matching scheme could elicit preferences from both refugees and receiving communities so that people end up where they want to be and where they are welcome. EASO has begun to develop such a matching scheme."

"Doctors from the World Health Organization and the Montreal-based Transplantation Society who were invited to the conference by China praised Chinese officials for reforms they have made in the transplant system, including a ban put in place last year on using organs from executed inmates.

"Doubts persist that China is accurately reporting figures or meeting its pledge given its severe shortage of organ donors and China’s long-standing black-market organ trade. By its own figures, China has one of the lowest rates of organ donation in the world, and even the system’s advocates say it needs hundreds of additional hospitals and doctors.

"While China suppresses most discussions about human rights, government officials and state media have publicly talked about their commitment to ending a practice opposed by doctors and human rights groups due to fears that it promotes executions and coercion.
...
"Others offered praise for Chinese officials, but stopped short of saying whether they could confirm China had stopped using executed inmates’ organs.

“It’s not a matter for us to prove to you that it’s zero,” said Dr. Francis Delmonico, a longtime surgeon and a professor at Harvard Medical School. “It’s a matter for the government to fulfill what is the law, just as it is in the other countries of the world that we go to.”

"China is believed to perform more executions than any other country, though the government does not disclose how many.

"The former vice minister of health, Dr. Huang Jiefu, publicly acknowledged in 2005 that China harvested executed inmates’ organs for transplant, and a paper he coauthored six years later reported that as many as 90 percent of Chinese transplant surgeries using organs from dead people came from those put to death.

"Huang has also responded to a report earlier this year that a Canadian patient apparently received a kidney from an executed inmate by announcing that the doctor and the hospital in question were suspended from performing more transplants."

"It is overwhelmingly evident that in the last two decades we have witnessed first-hand a remarkable and callous disregard for academic ethics and standards in a scramble by Canadian universities and colleges to sign up foreign students, who represent tens of millions of dollars to their bottom lines.
We have been in a school auditorium in China and listened to the school owner tell prospective parents that the Grade 12 marks from the Canadian provincial school board program can be manipulated to secure admission for their children into Canadian universities. This, while the Canadian teachers sat oblivious to the presentation in Chinese.
In hundreds of our own interaction with students who completed the Canadian provincial school board’s curriculum in China and who achieved grades of 70% and higher in their English class have been unable to achieve even a basic level of English literacy in the written tests we have administered. But when the largest country of origin for incoming international students and revenue is China - the Canadian universities admitting these students salivate over the dollars and focus less on due diligence.
We were once asked by a university on Canada’s west coast to review 200 applications from Saudi Arabia, in order to identify the two or three Saudi students who were actually eligible for conditional admission to that university's undergraduate engineering program. But the proposal was scuttled by the university's ESL department that wanted all 200 to enroll in its language courses. It insisted on and managed conditional admissions for all 200. It’s common at Canadian universities for the ESL program “tail” to wag the campus “dog” when it comes to admissions. In fact, recent Canadian government regulations have been proposed to crack down on this practice as it is an affront to academic integrity."

Tuesday, October 18, 2016

"Despite the progress, Canada lags behind "top-tier" countries such as the U.S. and Spain, where deceased donation rates exceed 30 donors per million population. Canada's rate currently stands at 18.2 donors per million population, up from 14.1 for that measure in 2006.

Spain fostered a culture of donation over three decades and Canada is now embarking on creating one, said Dr. Peter Nickerson, vice-dean of research at the University of Manitoba and a medical adviser to CBS.

About 21 per cent of donations come after cardiac death, said Kimberly Young, director of donation and transplantation at CBS. Before those programs were implemented, most deceased organ donations occurred after catastrophic brain injury. Now organs can be donated after the heart stops.

Young also acknowledged the hundreds of Canadians who've chosen to become living donors, many without ever knowing the recipient.

The living donation rate hasn't increased in the past decade, Young said. One of the reasons it hasn't decreased, as in some countries, is due to the national paired kidney donation program. It pairs compatible donors, including those in different parts of the country. Doctors consider kidney donations the best treatment for end-stage kidney disease.

Lung transplants are in the top tier of comparable wealthy countries, thanks to pioneering research at lung retrieval centres such as Toronto General Hospital, Nickerson said. Likewise, liver donation rates are high. Heart access is relatively equal, he said.

There have also been significant improvements in access to transplants among those who have the hardest time finding a donor match because of a highly sensitive immune system. "

Sunday, October 16, 2016

Here's an NBER paper by Nicola Lacetera, which includes this in the acknowledgments: "I dedicate this paper to the memory of my friend Julia Fletcher, whose life could have been longer if a bone marrow match were found for her."

NBER Working Paper No. 22673Issued in September 2016NBER Program(s): HEPE

Research shows that properly devised economic incentives increase the supply of blood without hampering its safety; similar effects may be expected also for other body parts such as bone marrow and organs. These positive effects alone, however, do not necessarily justify the introduction of payments for supplying body parts; these activities concern contested commodities or repugnant transactions, i.e. societies may want to prevent certain ways to regulate a transaction even if they increased supply, because of ethical concerns. When transactions concern contested commodities, therefore, societies often face trade-offs between the efficiency-enhancing effects of trades mediated by a monetary price, and the moral opposition to the provision of these payments. In this essay, I first describe and discuss the current debate on the role of moral repugnance in controversial markets, with a focus on markets for organs, tissues, blood and plasma. I then report on recent studies focused on understanding the trade-offs that individuals face when forming their opinions about how a society should organize certain transactions.

NBER Working Paper No. 22632Issued in September 2016NBER Program(s): HELEPE

Societies prohibit many transactions considered morally repugnant, although potentially efficiency-enhancing. We conducted an online choice experiment to characterize preferences for the morality and efficiency of payments to kidney donors. Preferences were heterogeneous, ranging from deontological to strongly consequentialist; the median respondent would support payments by a public agency if they increased the annual kidney supply by six percentage points, and private transactions for a thirty percentage-point increase. Fairness concerns drive this difference. Our findings suggest that cost-benefit considerations affect the acceptance of morally controversial transactions, and imply that trial studies of the effects of payments would inform the public debate.

"The Board had placed UPMC on probation in June 2015. Its lung transplant program had an unusually high number of instances where they accepted lung offers for one transplant candidate, then transplanted another candidate at the program. This inappropriately limited opportunity for consideration of other candidates identified on the match run."

"Five years after the surgery, when I was 23 and getting ready to go to medical school, I began working in a research lab that was looking at kidney donors who had gone on to develop kidney failure. For that research, I talked to more than 100 such donors. In some cases, the remaining kidneys failed; in others, the organ became injured or developed cancer. The more I learned, the more nervous I became about the logic of my decision at age 18 to donate.

"And then in 2014, a study looking at long-term risks for kidney donors found that they had a greater risk of developing end-stage renal disease. Another study that same year raised the possibility that they may face a heightened risk of dying of cardiovascular disease and all-cause mortality (although this point remains controversial).

"The truth is, it is hard to get good numbers about what happens to donors. Hospitals are required to follow them for only two years post-donation, which does not catch such long-term complications as chronic kidney disease, cardiovascular issues or psychiatric issues. There is no national registry for kidney donors or other large-scale means of tracking long-term outcomes."

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Here are some responses posted on Trio (TRANSPLANT RECIPIENTS INTERNATIONAL ORGANIZATION)

A recent news story appearing in the Washington Post talked about an 18 year old living kidney donor's concerns and regret for that donation. In a response to that, TRIO board member, Josh Morrison, offers his own thoughts on that concern based on his altruistic living kidney donation. Photo is of Josh and his unrelated recipient, John, whose story is shared in Josh's article linked below (along with a link to the original 'regret' story).

"Rule changes last year mean more healthy kidneys are available – bringing fresh hope to ­thousands of patients on the waiting list.

"From April 2015, it became possible for a stranger to give up a kidney and spark a series of donations. We have discovered that for each of 16 such donations, three people received a transplant.

"Previously, the chain was limited to two people who were in the National Living Donor Sharing Scheme, set up to allow pooling of organs from willing donors not a match for their own sick loved ones.

"Under triple transplant chains, a stranger’s kidney is allocated to the first recipient, a patient who is enrolled in the sharing scheme.

"In turn, the first recipient’s friend or relative, who wants to donate to their loved one but cannot because they are not a match, donates to another patient in the scheme, the second recipient.
...
"Any adult can ­volunteer to be ­considered an altruistic donor. You must be over 18 in England, Northern Ireland and Wales, and over 16 in Scotland.

The 16 Brits who gave their kidneys to patients they did not know first had several months of physical and psychological tests at their local transplant centre to ensure they were able to safely donate, and to confirm which recipients would be a suitable match."